LAUSR

OBJECTIVE To study if prostatic ductal adenocarcinoma (PDA) controlled by Grade Group (GG), PSA, and tumor volume (TV) is an independent predictor of adverse radical prostatectomy (RP) outcomes. MATERIALS One-hundred-and-twenty-eight PDA and 1,141 acinar continuous RPs were studied. Each tumor nodule (TN) was individually graded, staged, and its TV measured. Univariate analysis (UVA) identified features associated with lymph node metastasis (LN+), extraprostatic extension (EPE), positive surgical margins (SM+), and seminal vesicle invasion (SV+). We then assessed PDA effect on RP outcomes in a multivariate analysis (MVA). RESULTS In 127 cases PDA was present in 1 TN and no TN was pure PDA. One-hundred-and-twenty-three cases had PDA in TNs with highest grade, stage, and TV. Patients with PDA were older (65 vs. 63 years, p<0.001), had higher GG (p<0.001), and LN+ (6.3% vs 2.7%, p=0.049). Controlling these variables by GG eliminated statistical significance. Overall, there were 3,249 separate TNs (129 PDA and 3,120 acinar). In UVA, PDA predicted EPE (92/124 vs 517/3,045), SV+ (28/1129 vs 116/3,120), and SM+ (51/129 vs 296/3,120), all p<0.001. In MVA, PDA lost its effect on EPE (OR=0.88, p=0.64), SM+ (OR=0.86, p=0.5), and SV+ (OR=0.99, p=0.98). CONCLUSION Controlled for grade and TV, PDA was not an independent predictor of adverse RP outcomes, but former two were. Hence, higher GG and TV associated with PDA TNs may be predictive of adverse RP outcomes rather than PDA by itself. These conclusions may be used in preoperative risk stratification and definitive therapy planning when PDA is identified on needle biopsy.